P-041: DEATH ASSOCIATED WITH DELTA VARIANT COVID-19 AMONG SICKLE CELL DISEASE ADULT PATIENTS DURING THE 2021 4TH WAVE IN GUADELOUPE
Authors: BERNIT E., TARER V., HARDY-DESSOURCES M., TRESSIÈRES B., DOUMDO L., PETRAS E., ROMANA M., ETIENNE-JULAN M.
Journal: HemaSphere (2022)

Purpose: In Guadeloupe, a French West Indies Island of 379,710 inhabitants of which about 90% are of Afro-Caribbean origin, sickle cell disease (SCD) is the most common genetic disease. The Delta variant SARS-CoV2 4th wave was particularly deadly for the general population of Guadeloupe between July and October 2021 with 822 deaths attributed to COVID. We report here characteristics and prognosis of SCD adult patients infected by Delta variant during 4th wave. Materials and methods: This retrospective study was conducted at the Reference Center for SCD located in University Hospital of Guadeloupe. Results: Thirty-six SCD adult patients had symptomatic COVID-19 infection confirmed by nasal RT-PCR, with a sex ratio F/M of 2.6. None of them was vaccinated. The median age (IQR) was 43 years (27.0-50.0), 49 years (36.8-64.5) in SC patients, and 27.00 years (21.00-47.0) in SS patients (p=0.0007). Eighteen (50%) were SC, 15 (41.7%) were SS, and 3 (8.3%) were Sβ+-thalassemia patients. Body mass index (BMI) > 30 was observed only in SC patients (n=8). Nine patients had arterial hypertension, 13 had nephropathy with renal failure in one; three had mellitus diabetes. Three women were pregnant. Eleven SS, 1 SC, and 1 Sβ+-thalassemia were under Hydroxyurea treatment. Four SC patients had regular phlebotomies and 2 SS patients were on transfusion exchange program. Fifteen (41.7%) patients were hospitalized; among them, 4 had Dexamethasone, 4 had monoclonal specific therapy by casirivimab plus indevimab combination, 10 had transfusion and 1 transfusion exchange. Eight patients need oxygen supplementary. Among 21 (58.7%) outpatients, none had corticoid therapy and 3 received specific monoclonal therapy. Eleven needed oxygen support. Four (11.1%) patients died, all of them were SC patients. A 33-week pregnant 29-year-old woman was hospitalized with a vaso-occlusive crisis and developed pulmonary and neurologic symptoms with multivisceral failure despite high corticoid pulses, transfusion therapy, and delivery. An overweight 66-year-old woman with arterial hypertension and nephropathy died at home before medical management. A 48-year-old woman exhibiting obesity (BMI>45), arterial hypertension, asthma, nephropathy, and obstructive-sleep-apnea-syndrome (OSAS), was hospitalized for respiratory symptoms and died despite exchange transfusion, high corticoid pulses and tocilizumab. A 66-year-old man exhibiting obesity (BMI>35), arterial hypertension, diabetes, chronic renal failure and OSAS was hospitalized for worsening anemia and respiratory symptoms and died of probable myocardial infarction despite aggressive medical management. We compared the 4 deceased patients with the 32 survivors. Only median BMI and obesity were significantly different (p=0.009 and p=0.03 respectively). No difference were detected in terms of age, sex, genotype or other co-morbidity. Our numbers are too small to detect prognostic factors for death in the group SC patients. Conclusion: In this first Caribbean cohort of SCD patients infected with the delta variant, the SC genotype is over-represented (50%) whereas it represents only 36% of SCD patients followed in our referral center. However, our limited series does not allow us to conclude that SC genotype is a risk factor for mortality in COVID-19 infection. Further studies are needed to understand whether characteristics of this genotype or co-morbidities explain the severity. The authors do not declare any conflict of interest